Introduction Transgender women are at high risk for HIV infection, but less is understood about their rates of sexually transmitted infections (STIs) and the quality of sexual health services they receive. The Washington University Virology Clinic (St. Louis, MO USA) serves patients living with HIV; 2% of patients report being transgender women.
Methods We conducted a retrospective cohort study of transgender women living with HIV (n=41) to document frequency of testing for incident bacterial STIs [syphilis, gonorrhoea (GC), chlamydia (Ct)], with demographic information, markers of HIV care, and STI test results from 2011–2015.
Results Most patients were African American (91%) and on antiretroviral medications (>88%), although only 56% maintained HIV viral load suppression. Health challenges included a history of disrupted antiretroviral treatment (66%) and STIs (65%). Incident syphilis was diagnosed in 7.3% patients, and GC and Ct were diagnosed in 19.5% and 9.8% of patients, respectively. For syphilis screening, 90% of patients were tested at least once a year, and 53% of patients were tested more than once a year. For GC/Ct screening, 89% of patients were tested at least once a year and 49.3% of patients were tested more than once a year. For patients with GC or Ct infection, only 44% of patients were retested at the site of infection 3–6 months after treatment. Reinfection with GC or Ct was subsequently diagnosed in 19.5% of patients. Frequency of three site testing for GC/Ct (genital, rectal, pharyngeal) increased over the course of the study period (from 3% of patients to 34% of patients, X2=17.69, p=0.001).
Conclusion Transgender women living with HIV are at high risk for incident bacterial STIs. Frequency of testing for STIs increased over a five-year period, but many patients with documented infection were not re-tested after treatment as recommended by current guidelines. Understanding STI rates, primary locations of infection, and lack of retesting in patients will improve patient education and standardise care for patients.
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